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TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 

RUPERT BLUE, Surgeon General 



SCHOOL MEDICAL INSPECTION 



BY 



TALIAFERRO CLARK 

Assislani Surgeon General 
United States Public Health Service 



REPRINT No. 554 

FROM THE - 

PUBLIC HEALTH REPORTS 

September 5, 1313 
(Pages 2013-201S) 



^-2-7 ^^"2- 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1919 



LB 34// 
.06 



ADDITIONAL -COPIES 

OF THIS PUBLICATION MAT BE PKOCUEED FEOM 

THE SUPERINTENDENT OF DOCUMENTS 

GOVERNMENT PRINTING OFFICE 

WASHINGTON, D. C. 

AT 

S CENTS PER COPY 



NOV 



•f J. 

29 



SCHOOL MEDICAL INSPECTION.^ 

By TAU.u-EEEO Clakk, Assistant Surgeon General, United States Public Health Servico. 

With tlie time for the opening of the schools drawing near it is 
very desirable that communities, and especially the responsible 
officials, should take stock of resources for the health supervision of 
school children. Owmg to inevitable adjustments that are now 
taking place in the national life as a result of the war, and especially 
in view of the changed economic conditions, the increased cost of 
the necessities of life, and the strong appeal of greater remunera- 
tion in other fields to those engaged in health activities, the impor- 
tance of adequate health supervision of the children of the land is 
emphasized as never before in the history of our country. 

The Advantage of Health Supervision of School Children. 

The health of the growing child determines largely the health 
and bodily vigor of the grown man. The community, therefore, can 
take no more important step to insure the future efficiency of its 
citizens than that of growing healthy children. In the present state 
of society an intelligent supervision of the health of the children during 
the period of school life is probably one of the most potent measures 
for this purpose and is recognized as such by law in an increasing 
number of the States of the Union. This is especially true since in 
but a very few fortunate communities is any attention whatsoever 
given to general health supervision of children durmg the impres- 
sionable preschool age covering the period from 2 to 5 years of age, 
inclusive. 

Intensive studies of the physical conditions of children in many 
places have shown large numbers of them to have physical defects 
which were previously um-ecognized and unsuspected. Many of the 
defects thus shown are preventable and remediable. Their persistence 
results not only in reduced individual efficiency, but also, in the 
aggregate, in reduced national efficiency, as is so clearly shown by the 
high percentage of those found unfit for military service in the 
physical examinations conducted under the selective-service law. 

The conditions under which children assemble in school, and not 
the school itself, are largely responsible for much of the siclmess 
contracted during the period of school life and for the persistence 

1 Reprint from the Public Health Reports, vol. 34, No. 36, Sept. 5, 1919, pp. 2013-2018. 
139880°— 19 . 3 



4 SCHOOL MEDICAL INSPECTION. 

of physical defects. The control of adverse causes durmg this 
period not only exercises an immediate beneficial effect on the 
health of the children, but serves most effectively to teach them the 
principles of personal hygiene, the nonobservance of which is now 
believed to be mainly responsible for the large annual increase in the 
number of deaths from degenerative diseases that occur later in life. 

Experience shows that the failure to prevent and correct impair- 
ment of hearing and vision and to detect abnormalities of color 
perception, to secure dental attention, to alleviate postural defects, 
to place the normal child in an environment best suited for physical 
development, greatly restricts the range of industrial, business, and 
professional opportunity in adult life. Moreover, a number of 
defective children are unable to take full advantage of their educa- 
tional opportunity. They fall behind in school work, become dis- 
couraged because unable to keep pace with normal children in their 
classes, and ultimately quit school poorly prepared for useful citizen- 
ship. It is of prime importance to the commmiity, therefore, to take 
cognizance of these i^ossibilities in order that steps may be taken to 
prevent them. Furthermore, the control of the communicable 
diseases in the community can be accomplished more effectively when 
xmdertaken in connection with the medical inspection of school 
children. Altogether, the loss of life, the impairment of hearing and 
vision, the tendenc}'' to degenerative diseases caused by neglect of 
personal hygiene, and the loss of time in school work render it highly 
desirable from the economic standpoint alone to inaugurate a 
measure so potential in the control of the commamicable diseases. 

A Desiral^ System of Health Si^ervisien ©f Scbool C^lsskesi 

An effective systemi of health supervision of school children should 
provide (1) for the thorough sanitation of all buildings used for school 
purposes; (2) for the intelligent supervision of classrooms to detect 
and correct conditions injurious to the health of the pupils as soon as 
they arise; (3) for the full-time services of medical inspectors qualified 
to discharge the sanitary and medical duties of the school physicians, 
(4) for the full-time services of school nurses; (5) for facilities for 
dental inspections; (6) provision whereby necessitous children may 
receive free treatment best suited to their needs; and (7) for a thorough 
mental examination of all children v^'-ho fail to progress normally in 
schoolwork. Objections have been made to health supervision of 
school children and the treatment of their physical defects on the 
ground that such measures discriminate against the regular practice 
of medicine, encourage pauperism in parents, raise the tax rate, and 
tend to bring about a lowered sense of responsibility on the part of 
parents in respect of the health of their children. The experience of 
countries and communities wherein these measures are in full force 



SCHOOL MEDICAL INSPECTION. 5 

does not siAstantiate these claims. It has been found that the more 
regular attendance of children at school brought about by competent 
health supervision, and the educational effect on parents of such 
me'asures when applied to their children, reflect in time so advan- 
tageouslj'' on the community as to more than compensate for the 
expenditures involved in such supervision. 

Scope of Medical Inspection. 

The demands of a reasonable medical inspection of school cliildren 
are met by the following observances: (1) To examine for the presence 
of physical or mental defects which make it inadvisable for certain 
children to attend school; (2) to measure and weigh all children to 
detemiine the average physical development by sex and one-year 
age periods, and the utilization of such standards as an index of 
nutrition and as a guide to the discovery of harmful causes in the 
case of children who do not develop normally; (3) to discover, re- 
move, and prevent defects of dentition, hearing, posture, and vision 
that hamper children in schoolwork and retard their physical and 
mental development; (4) to aid the health authorities in the control 
of communicable diseases. 

Requirements of a School Medical Inspector. 

The minimum requirements of an acceptable school physician are: 
(1) That he should devote his full time to the supervision of the 
health of school children; (2) that he should be skilled in medical 
diagnosis, able to advise with and assist the family physician when 
it is so desired; (3) that he should have a knowledge of bacteriology 
sufhcient to enable him to take cultures, detect "carriers," and other- 
wise assist the health authorities so that it may be unnecessary to 
close schools during epidemics of communicable diseases ; (4) that he 
should be V\^ell grounded in the principles of personal and general hy- 
giene and, have the ability to apply them to school purposes; (5) that 
he should be competent to prescribe suitable exercises in individual 
cases to overcome postural defects, and advise with regard to regulated 
group exercises designed to promote the best physical development of 
normal children; (6) and that he should notify all parents of the 
presence of physical defects in their children as soon as these defects 
are discovered and make reasonable efforts to have his recommenda- 
tions carried out. 

In the selection of a school physician due regard should be given 
to his ability to direct the seating of children, to make observation of 
atmospheric conditions in classrooms, to measure illumination and to 
advise in regard to changes necessary to secure the maximum of 
illumination with the minimum of visual discomfort, and finally to 
advise janitors in respect of the heating and ventilation of school 
buildings. 



6 SCHOOL MEDICAL, IIs^SPECTIOIsr. 

The employment of a physician engaged in private practice to 
devote a part of his time to the medical inspection of school children 
is not productive of good results. On the average it requires the 
full time of a speciallj^ qualified ph3^sician to supervise effectively the 
health of 2,000 school children. Furthermore, the employment of a 
practicing physician for this purpose is frequently the cause of jealousy 
and opposition on the part of other local practitioners that negative 
the efforts of the school physician. 

One of the great drawbacks to the employment of a school physician 
heretofore has been the apparent unwillingness of the school and 
health authorities to recognize and clearly define their duty in respect 
of school health-supervision. Fundamentally, the duty of the school 
organization is to impart instruction, and this should include instruc- 
tion in health through courses in personal and general hygiene adapted 
to the needs of various age-groups and by the organization of classes 
in physical training. 

On the other hand the function of the health department is pre- 
ventive and corrective, and as applied to school health-supervision 
should include the medical examination of the children for the detec- 
tion and removal of the hampering physical defects and for the control 
of communicable diseases, as well as supervision of the sanitation of 
the school buildings and grounds and playgrounds. In fact, the 
measure of the mental and physical efficiency of the children of a 
community will be largely proportional to the completeness of the 
cooperation of these two responsible agencies in this work. 

Dental Attention. 

Dental defects constitute the most numerous of all defects found 
during medical inspection. The percentage of children in need of 
attention to the teeth is highest among those from 5 to 8 years of age, 
the percentage gradually decreasing in successive older age-groups. 
It is now recognized quite generally by the medical and dental pro- 
fessions that defective teeth are responsible for serious disturbances 
of the general health. Especially is this true of "rheumatic" affec- 
tions, heart disease, and gastric disturbances. No system of health 
supervision of children can be thoroughly effective, therefore, that 
does not secure correction of dental defects or fails to instruct parents 
in dental prophylaxis. 

Duties of the School Nurse. 

The school nurse should be directly responsible to the school 
physician for the proper discharge of her duties. Her activities 
should supplement those of the school physician and correlate with 
them. She should have sufficient training to carry out the routine 



SCHOOL, MEDICAL IlS^SPECTIOi^. 7 

treatment of minor ailments in necessitous children under supervision 
of the school physician; she should be required to visit the parents of 
ailing children, when necessary, to instruct them in the care of the 
sick and in the prevention of disease; she should ''follow up" children 
recommended for treatment by the school physician to induce parents 
to carry out his recommendations in case of their failure to do so ; she 
should from time to time visit children who have been excluded from 
school for purposes of treatment, to insure their return without undue 
loss of time; she should be required to visit children absent from 
school for three successive days from unexj)lained causes, and in case 
of sickness make inquiry as to its nature in order to guard against 
communicable diseases; she should report the results of follow-up 
work to the school physician so that they may be properly recorded. 
The services of the school nurse may be advantageously used during 
the vacation period in infant welfare work, or in some other form of 
community health supervision. 

Recording and Preservation of the Results of Medical Inspection. 

Every child should be subjected to a rigid medical examination. 
as soon as possible after first entering school. The results of such 
exammation should be card indexed and filed in such manner as to 
be instantly available for reference. Immediately following the ex- 
amination, the parents of the child should be notified, in writing, of 
the presence of physical conditions which require medical or surgical 
attention. Such notification should be supplemented by visits from 
the school nurse, and neglectful parents should be advised of the 
necessity for such attention. 

The form used for recording physical defects and other information 
regarding the school children should be arranged to suit the demands 
of local conditions. In general, such cards should show the name and 
address of the child, the name and address of parents or guardian, 
the exact date of birth, the sex and nationality of the child, the 
height and weight, the physical defects at the time of the examination, 
and such other information as may be useful. The subject matter 
should be so arranged as to provide space for recording the results of 
reexaminations in succeeding years. Such cards should also indicate 
the treatment advised, the results of treatment, and the subsequent 
disposition of each particular case. 

Dental defects should be recorded on a card of the same size as 
the medical-inspection card, and filed with it. Such cards may be 
conveniently arranged showing cuts of the temporary and per- 
manent teeth, with spaces for recording the results of dental inspec- 
tions and treatment. 



SCHOOL, MEDIC-iL IXSPECTIO]!T. 



The notification blank to parent or guardian may be arranged as 
follows : 



Office Medical Inspector of Schools. 

raront or guardian. Address. 

A recent physical inspection of 

Name of child. 

attending the indicates the following 

Kame of school. 

abnormal conditions: 



You are ad\ised to take to your 

Name of eliild. 

family physician, dentist, oculist, or to a dispensary for advice and treatment. 

Medical inspector. 



In every case where the child is excluded from school on account 
of sickness or disability, the medical inspector should be rec[uircd to 
notify, in writing, the parent or guardian, specifjnng the cause of 
such exclusion and stating explicitly the terms under which the child 
may return to school. 

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